1. Local leaders and MPs must embrace NHS England vision

    23 Oct 2014
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    It’s the report the NHS has been waiting for. 

    Simon Stevens’ vision for the future of how care will be organised and delivered in England is set out in the Five Year Forward View – the first time the arm’s length bodies in the NHS have come together to produce such a report. 

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  2. 10 top tips for managing difficult service change

    (Guest blogger)
    14 Mar 2014
    Comments

    “It constantly surprises me that my colleagues don’t recognise the power of personal leadership”.

    This is one of the quotes from a study of successful service reconfigurations. All across the economy leaders have to change services – often asking users to accept different modes of delivery for financial reasons. But across the NHS, some manage it well, whereas others effectively blow their toes off one by one with a shotgun.

    Why? One is assuming that the public and colleagues are rational, and once they realise the basis of your sensible arguments, they will go along...

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  3. Is the NHS a safer place a year after the Francis Report?

    6 Feb 2014
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    Imagine that today, February 6 2014, you’ve just said goodbye to your elderly mum or dad, looking small, lost and confused in a hospital bed. They’ve been admitted after a fall at home and you’ve been told they’ll be in for a few days, and not to worry because they are in safe hands.

    But you do worry, because you remember reading all those stories about what happened in Mid Staffordshire Hospital. You worry about whether, at 2am in a darkened ward, there isn’t something similar going happen to your mum or dad, if they won’t be...

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  4. Back to the future hospitals?

    (Guest blogger)
    20 Sep 2013
    Comments

    Often a crucial report crystallises existing thinking and developments. If that is the case with the Royal College of Physicians’ Future Hospital Commission’s report, patients may be able to look forward to significant improvements in hospital care.

    As a health service historian I am fascinated by the ‘big ideas’ that colour thinking about our health service system. The first is that of the ‘system’ itself, the way in which over 200 years hospitals have progressively given up rugged independence to act as...

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  5. Keeping our NHS fit for the future

    (Guest blogger)
    25 Jun 2013
    Comments

    If we stand back now, the NHS may tip over the edge of its own ‘fiscal cliff’. Future health care services face serious challenges such as changing demographics (particularly ageing), increasing obesity levels and rising costs of new treatments and medicine.

    To do nothing about the increasing demands being placed upon the system would be a political mistake.

    I believe that the current infrastructure, and the widespread and relatively unchallenged acceptance of a service funded solely by the taxpayer, will lead to poorer patient outcomes than we should...

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  6. The 'new' NHS and the emergency care challenge

    (Guest blogger)
    19 Apr 2013
    Comments

    This is a critical time for the NHS, with many key themes to discuss. But my start to the year is dominated by emergency care – a very practical challenge but one that raises important questions about culture too.

    Across the NHS we are really struggling with emergency activity. Even allowing for Norovirus and prolonged cold weather we are experiencing unusual pressure.

    The...

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  7. NHS productivity: more of the same or more for less?

    (Guest blogger)
    5 Mar 2013
    Comments

    The Francis report has pushed money well down the pecking order as quality takes first, second and third place.

    But as we come to the end of the financial year some eyes will again turn to how well the service is maintaining financial balance, meeting the Nicholson challenge of £20 billion savings and raising quality.

    We know that the NHS needs to increase productivity to make savings, raise quality and balance the books. The consensus is that NHS productivity flat-lined over much of the last...

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  8. Clinical commissioning groups: ready for take off?

    1 Mar 2013
    Comments

    As clinical commissioning groups (CCGs) prepare for 1 April, one has to wonder how ready they really are to take full responsibility for local strategic planning and purchasing of health care.

    The coming year will be one of immense challenge in terms of the quality and safety of health care, particularly in light of the Francis Inquiry’s call for a fundamental change in NHS culture.

    And all of this at a time when NHS funding is flat and the NHS Commissioning...

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  9. Asking tough questions about primary care

    (Guest blogger)
    13 Feb 2013
    Comments

    Health care reformers tend to focus attention on hospitals and payment systems and yet primary care, where most patients are seen, receives comparatively little attention.

    While it is acknowledged that hospitals are now poorly suited to the different types of patients they have to treat, the fact that primary care faces similar problems is rarely acknowledged. The recent Nuffield Trust European Health Summit, supported by KPMG sought to redress this balance.

    Across Europe, primary care is often characterised by small and isolated practices, with few...

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  10. GP and CCG relations: what are the challenges?

    2 Aug 2012
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    As clinical commissioning groups (CCGs) head towards authorisation, the constitutional arrangements that link member practices to the governing bodies of their CCG are taking shape.

    Advice from Local Medical Committees (LMC) and the British Medical Association (BMA) has cautioned against signing a constitution without explicit dispute procedures and which lack a clear commitment to engage with the LMC.

    ...

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  11. Does universalism have a future?

    17 Jul 2012
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    In these times of austerity, the future of universalism is uncertain. The question is: would it be a more prudent use of Government funds and taxpayers’ money to routinely restrict benefits solely to those in need?

    This was the topic of debate at our annual reception and debate, expertly explored by Chair Mark Easton of the BBC and panellists Rt Hon Frank Field MP, Polly Toynbee, Julia Unwin CBE and Rt Hon David Willets MP, with an introduction by Professor...

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  12. Deciding what to fund in health: national directives or local autonomy?

    27 Feb 2012
    Comments

    As the purchaser of health services for the British population, the NHS has always had to make hard choices about who is eligible for treatment, what services to cover and what criteria patients need to meet before treatment is administered.

    In recent months in particular, there have been extensive debates about who bears responsibility for making these decisions and the basis on which they should be made.

    These include questions about how the duties of the Secretary of State for Health should be framed, the extent to which the NHS Commissioning Board (now...

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  13. Keeping patients' trust

    (Guest blogger)
    17 Feb 2012
    Comments

    Last year the Archbishop of Canterbury attacked what he described as "the quiet resurgence of the seductive language of the deserving and undeserving poor".

    The pressure to make huge savings within the NHS, coupled with the commissioning agenda and the introduction of private competition to that process could see the deserving and undeserving poor joined by the deserving and undeserving sick. This can't be right. After all, no one chooses to be sick.

    When I hear insulting terms like "frequent flyers" being used to describe people who are sick and need...

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  14. We need to talk about rationing

    11 Oct 2011
    Comments

    I was struck by the general appetite for a more open debate about rationing and priority setting at a recent conference on priority setting in health held by the University of Birmingham’s Health Services Management Centre (HSMC) and the Nuffield Trust.

    The conference focused on the experiences of primary care trusts (PCTs) in making difficult choices. During the morning session HSMC’s Dr Suzanne Robinson introduced findings from research published by the Nuffield Trust that explored current priority-setting...

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  15. To fund or not to fund: setting priorities in the NHS

    15 Sep 2011
    Comments

    The 'Nicholson' challenge necessitates the making of difficult decisions by NHS commissioners. Most of the clinical commissioning groups (CCGs) that will emerge in 2013 look set to be smaller than the primary care trusts (PCTs) they are replacing, and with significantly less management support whilst – crucially – bearing similar legal liabilities.

    However, when it comes to setting and accounting for funding priorities, the...

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  16. NICE and the NHS Constitution: a partial reprieve for clinical commissioners?

    11 Aug 2011
    Comments

    An interesting thing occurred when Andrew Lansley announced that NICE would no longer recommend which drugs and treatments should and should not be offered on the NHS – NICE became, well nice.

    The alternative, new local commissioners having to make these decisions at a local level looked inequitable and unworkable.  After all, NICE has been a lightening conductor for public anxiety around rationing, and has taken difficult and highly technical decisions out of the hands of local commissioners.

    Following a recommendation from the...

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